Class of 2016 Abstract / Objectives: To compare health-related quality of life (HRQoL) among stroke survivors by gender and race/ethnicity to identify gender and racial/ethnic disparities. Methods: This study adopted a retrospective cross-sectional research design utilizing data from the 2013 Behavioral Risk Factor Surveillance System (BRFSS), a state-based telephone survey administered to noninstitutionalized United States citizens. Inclusion criteria for this project were adults aged 50 or older who: participated in the 2013 BRFSS survey; indicated they had ever been told by a provider that they had experienced a stroke (of any type); and reported data on seven questions aimed to assess HRQoL (general, physical, and mental health; life satisfaction; emotional support; activity limitations; and sleep quality). Chi square tests and logistic regression models were used to compare HRQoL responses by gender and race/ethnicity. Results: In the 2013 BRFSS database 20,391 of 491,773 respondents reported experiencing stroke. Of those, 16,561 met the inclusion criteria. The majority were female (61.1%) and identified their race/ethnicity as white (78.6%). Logistic regression analysis revealed females were more likely than males to report worse outcomes across the following three HRQoL domains: activity limitations (AOR=0.752, 95% CI 0.617-0.918); mental health (AOR=1.398, 95% CI: 1.110-1.761); and general health (AOR=0.764, 95% CI: 0.588-0.993). Minority populations (African American, Hispanic, and Other) were more likely to report activity limitations (AOR=0.766, 95%CI: 0.614-0.955) and fair/poor general health (AOR=1.837, 95%CI: 1.324-2.549). Conclusions: Analysis identified gender and racial/ethnic disparities in HRQoL indicators among stroke survivors. Females and minority populations were more likely to report poorer outcomes.

Yes / Background: Loneliness in older people is associated with poor health-related quality of life (HRQoL). We undertook a parallel-group randomised controlled trial to evaluate the effectiveness and cost-effectiveness of telephone befriending for the maintenance of HRQoL in older people. An internal pilot tested the feasibility of the trial and intervention. Methods: Participants aged >74 years, with good cognitive function, living independently in one UK city were recruited through general practices and other sources, then randomised to: (1) 6 weeks of short one-to-one telephone calls, followed by 12 weeks of group telephone calls with up to six participants, led by a trained volunteer facilitator; or (2) a control group. The main trial required the recruitment of 248 participants in a 1-year accrual window, of whom 124 were to receive telephone befriending. The pilot specified three success criteria which had to be met in order to progress the main trial to completion: recruitment of 68 participants in 95 days; retention of 80% participants at 6 months; successful delivery of telephone befriending by local franchise of national charity. The primary clinical outcome was the Short Form (36) Health Instrument (SF-36) Mental Health (MH) dimension score collected by telephone 6 months following randomisation. Results: We informed 9,579 older people about the study. Seventy consenting participants were randomised to the pilot in 95 days, with 56 (80%) providing valid primary outcome data (26 intervention, 30 control). Twenty-four participants randomly allocated to the research arm actually received telephone befriending due to poor recruitment and retention of volunteer facilitators. The trial was closed early as a result. The mean 6-month SF-36 MH scores were 78 (SD 18) and 71 (SD 21) for the intervention and control groups, respectively (mean difference, 7; 95% CI, −3 to 16). Conclusions: Recruitment and retention of participants to a definitive trial with a recruitment window of 1 year is feasible. For the voluntary sector to recruit sufficient volunteers to match demand for telephone befriending created by trial recruitment would require the study to be run in more than one major population centre, and/or involve dedicated management of volunteers. Trial registration: ISRCTN28645428.

Introduction: Each year 1200-1300 patients are diagnosed with head neck cancer. Treatment that involves radiotherapy can cause severe side effects for example trismus that affects quality of life. Purpose: To study health-related quality of life in patients who have undergone radiation treatment for head and neck cancer and participated in a intervention group who received training intended to prevent trismus or in a control group who received standard treatment. Method: This is a prospective study in which data is collected from 66 patients participating in a randomized study aiming to evaluate a training program to prevent trismus. Thirty three participated in the intervention group and thirty three in the control group. Both patient groups assessed health related quality of life (HRQOL) with EORTC QLQ C30 and QLQ-H&N35, at start and end of the radiation treatment, and at 3 and 6-months after completing radiation treatment. Results: There is no difference between the intervention and control groups regarding symptoms, functional status and global health, except for intake of nutritional supplements.  For both groups almost all scales measuring HRQOL deteriorated under the radiation treatment. However, 3 and 6 months after end of radiotherapy HRQOL had improved and had returned to the baseline values. The only exceptions were dry mouth, sticky saliva, problems with social eating, senses and physical ability. Conclusion: Radiation therapy for head and neck cancer affects patients HRQOL both in the short and long term. Medical staff needs strategies to manage patients ' functional and symptomatic deterioration throughout the treatment period and try to prevent or relieve the symptoms that may still remain several months after radiotherapy.

Polycystic Ovary Syndrome (PCOS) is one of the most common endocrine disorders amongst women, estimated to affect one out of 10 women. Symptoms include infertility, obesity, alopecia, acne, hirsutism and menstrual irregularities. Women with the syndrome are also more likely to experience co-morbid physical and psychological conditions such as diabetes, heart disease, endometrial cancer and also depression and anxiety. PCOS has also been found to have a negative impact on quality of life. This thesis aimed to further understanding, and improve quality of life of women with PCOS in the UK. To achieve this, the thesis aimed to investigate and identify how women with PCOS in the UK perceive and define their quality of life and to further understanding of the day-to-day experience of living with PCOS. Moreover, in order to measure quality of life, it aimed to develop and validate a UK disease-specific quality of life measure for women with PCOS. It also aimed to identify, develop and test a pilot intervention to increase quality of life in women with PCOS. To achieve these aims a mixed-methods approach was taken employing a variety of data generation and collection methods including: photovoice, online Skype™ interviews; LimeSurvey and Qualtrics. The findings of this thesis emphasise that PCOS has a negative impact on quality of life; encompassing psychological, social, environmental, and physical domains of quality of life. Women with PCOS who experienced the symptoms of infertility, hirsutism, weight, alopecia, skin discolouration, skin tags and mood swings had significantly lower scores of overall quality of life than those women who did not experience the symptoms. In addition, those women with PCOS who had a diagnosis of anxiety and/or depression had reduced quality of life. The dissemination of these findings will enable health care professionals to better understand the experience of living with PCOS and its impact on quality of life. Moreover, this thesis identifies many areas for future research which will enable a better understanding of the impact of PCOS on quality of life. Finally, this thesis makes recommendations for clinical practice which include improvement of support from health care professionals for women with PCOS in order to help them better manage their symptoms, and therefore improve their overall quality of life.

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Bakgrund: Syftet med palliativ omvårdnad är att främja hälsorelaterad livskvalitet (HRQoL) för personer som vårdas och att ge stöd till anhöriga.  För att kunna erbjuda god palliativ omvårdnad i öppenvård, slutenvård eller hemsjukvård krävs att sjuksköterskan har en förståelse för hur personer i palliativt skede skattar sin HRQoL. Syfte: Syftet var att beskriva faktorer som påverkar HRQoL för personer i palliativt skede. Metod: Litteraturöversikt av 14 vetenskapliga artiklar med kvantitativ design. Sökningen har skett i databaserna CINAHL och Pub Med. Analys har skett med hjälp av Fribergs trestegsanalys. Resultat: Resultatet visar att flera faktorer samverkar i personers självskattning av HRQoL. Faktorerna sammanfattas i tre beskrivningskategorier; symtombörda (social och emotionell påverkan, sista tiden i livet), vårdens påverkan (tidigt insättande av palliativ vård) och behandling (positiv, negativ) på HRQoL. Slutsats: För att sjuksköterskan ska kunna stödja personer som vårdas i palliativt skede, och de anhöriga, att kunna uppleva god HRQoL behöver sjuksköterskan kunskap om vilka faktorer som påverkar HRQoL för den de vårdar. Examensarbetet kan ge sjuksköterskan fördjupad förståelse för faktorer som påverkar HRQoL för personer som vårdas i palliativt skede och därmed möjliggöra förbättrat personcentrerat omhändertagande 0ch främja upplevd HRQOL. Nyckelord: Hälsorelaterad livskvalitet (HRQoL), kvantitativ, palliativ vård och vuxna. / Factors that affect health-related quality of life for people in palliative phase – a literature review Background: The purpose of palliative care is to promote health-related quality of life (HRQoL) of the person as well as providing support for relatives. In order to provide good palliative care in day care centers, inpatient units or home care it is vital that the nurse understands how people in the palliative phase values and self-reports their HRQoL. Aim: The purpose was to describe factors that affect HRQoL for people in palliative phase. Method: Literature review of 14 scientific articles with quantitative design. The search has been conducted in the databases CINAHL and Pub Med. The analysis was implemented using Friberg’s three-step analysis model.    Result: The results show that several factors interact in people’s self-assessment of HRQoL. The factors are summarized in three descriptive categories; the impact on HRQoL from symptom burden (symptoms; social and emotional impact; end of life), care (access to; early access) and treatment (positive impact; negative impact) respectively. Conclusion: In order for the nurse to be able to promote the experience of good quality of life for people in palliative phase, and their relatives, knowledge is vital about which factors affect the quality of life for the person they care for. The degree project can provide the nurse with an immersed understanding of theese factors and thus enable improved person-centered care and promote the perceived HRQoL. Keywords: Health-related quality of life (HRQoL), quantitative, palliative care and adults.

Syfte: Det övergripande syftet med denna licentiatavhandling är att beskriva resultat från en kartläggning av hälsosituationen hos nyanlända flyktingar som genomgår SFI studier samt att belysa den självskattade hälsorelaterade livskvalitet som arabisktalande deltagare i en specifik hälsofrämjande gruppaktivitet (Hälsoskola) beskriver före, efter samt vid en sexmånaders uppföljning av aktiviteten. Design, metod, urval: Urvalet deltagare i delstudie I var nyanlända arabisktalande flyktingar bosatta i Fosie stadsdel i Malmö och som deltog i SFI utbildning. Undersökningsgruppen bestod av sammanlagt 67 personer, 52 procent män och 48 procent kvinnor. Datainsamlingen genomfördes med hjälp av frågeformulär innehållande frågor om familj och anhöriga, nätverk och service, svenskundervisning och delaktighet, introduktion och hjälpbehov samt om sömn och återhämtning. I delstudie II bestod urvalet av arabisktalande nyanlända flyktingar som genomgick en sju veckors Hälsoskola som en del i sin introduktionsplanering. Dataunderlag bestod av kvalitativa data inhämtat vid deltagande observationer och muntliga grupputvärderingar med 65 kursdeltagare. Därutöver besvarades ett frågeformulär för självskattning av hälsorelaterad livskvalitet samt om sömn och återhämtning. Frågeformuläret besvarades vid kursstart, kursavslutning samt sex månader efter kursens slut. Respondenter i denna del var 39 kursdeltagare som besvarat samtliga tre frågeformulärsomgångar. Därutöver innehåller avhandlingen en artikel vars syfte är att beskriva kursen/metoden Hälsoskola, dess bakgrund och teoretiska kopplingar samt den samverkansprocess som utvecklats mellan professionella aktörer och brukare. Resultat: I delstudie I rapporterade respondenterna hög förekomst av sömn- och trötthetsbesvär. Sextioåtta procent av respondenterna hade sömnproblem motsvarande hälften av veckans dagar. Något färre 43 % rapporterade regelbundna besvär med sömnighet, till exempel att man nickade till under dagen. Fyrtioen procent (män 36 %, kvinnor 50 %) uppfyllde kraven för klinisk insomni baserat på att respondenterna hade både sömnbesvär och trötthetsbesvär under minst hälften av veckans dagar. Därutöver upplevde drygt 80 % av samtliga stor oro över sin familj eller andra anhöriga i hemlandet. Många kände sig isolerade och ensamma, hade svårt att få kontakter med föreningsliv, få tillgång till platser för kulturella aktiviteter, för religionsutövning och för sportaktivitet. Många upplevde också svårighet att få tillgång till hälso- och sjukvård samt tandvård. I utbildningssituationen upplevde drygt hälften stora svårigheter att förstå vad läraren sade och 68 % hade svårt att hinna med i tempot på lektioner. Drygt 64 % rapporterade koncentrationssvårigheter, de hade problem att förstå hemuppgifter liksom att kunna göra hemuppgifter i lugn miljö. För många respondenter rådde oklarhet om introduktionsplanen och cirka hälften av dem hade velat få mera hjälp av sin introduktionshandläggare med läkar- och sjukvårdskontakter samt med sin bostadssituation. I den kvalitativa delen av delstudie II vars syfte var att belysa de viktigaste frågorna från deltagarnas synvinkel, utkristalliserade sig fyra kategorier: 1) Fördjupningsfrågor beträffande innehåll i kursen/Hälsoskolan. 2) Kommentarer angående form och struktur på kursen/Hälsoskolan. 3) Vilka av kursdeltagarnas ”behovsområden” som kursen/Hälsoskolan täcker in och vilka områden som saknas? 4) Vad kursdeltagarna önskar få framfört till administratörer, beslutsfattare och politiker. I den kvantitativa uppföljningsstudien framkom att deltagarna upplevde en hög grad av sömn och koncentrationsproblematik vid kursstart. Denna problematik var betydligt mindre vid kursens avslutning och förändringen kvarstod vid uppföljning sex månader senare. Det framkom även att sömnproblematik var relaterad till de fem variablerna av hälsorelaterad livskvalitet;( rörlighet, aktivitet, egenvård, smärta och oro/depression) och till upplevelsen av det allmänna hälsotillståndet. Angående variablerna smärta och oro/depression kvarstod en signifikant förändring både vid uppföljning ett och vid uppföljning två sex månader efter kursavslut. Både män och kvinnor bedömde sitt allmänna hälsotillstånd som signifikant bättre vid båda uppföljningarna jämfört med vid kursstart, men förändringen var störst beträffande kvinnorna. Konklusion: De sammantagna resultaten visar att det finns en hög fysisk och psykisk ohälsoproblematik i den undersökta populationen med avseende på deras självskattade hälsa. Denna problematik har ett nära samband med sömn och koncentrationsproblem och får även konsekvenser för de nyanländas dagliga aktiviteter och etablering i det nya samhället. Det framkommer ett stort behov av hjälp från hälso- och sjukvården men också en brist på tillit till detsamma, bland annat beroende på svårtillgänglighet och brist på professionella tolkar. Å andra sidan visar resultaten i denna licentiatavhandling att mottagningssystemet med noga överlagda insatser kan åstadkomma betydande positiva förändringar för gruppen nyanlända flyktingar. Den självupplevda hälsorelaterade livskvaliteten för deltagare i kursen Hälsoskola visade på signifikanta förändringar inom de undersökta aspekterna för gruppen som helhet vid kursslut och vid senare uppföljning. De reella faktiska kunskaperna inom egenvård och om det svenska hälso- och sjukvårdssystemet hade ökat betydligt vid kursavslut. Nämnda effekter kan även få positiva följdverkningar för nästa generation och andra personer i kursdeltagarnas nära omgivning. / Aim: The overall aim of this thesis is to describe the results of a survey of the health situation of newly-arrived refugees attending a course in Swedish for Immigrants (SFI) (study I) and elucidate the self-rated health-related quality of life that Arabic-speaking participants in a spe-cific health-promoting group activity (Health School) report before, immediately after and at a six-month follow-up of that activity (study II). Design, method, sample: The sample in study I comprised newly-arrived Arabic-speaking refugees living in the Malmö district of Fosie who were attending a SFI course. A total of 67 persons participated, 52 per cent men, 48 per cent women. Data were collected with the aid of a questionnaire with both open-ended and closed alternative responses about family and relatives, networks and services, Swedish language lessons and participation, introduction and needs, sleep and recovery. In study II the sample comprised newly-arrived Arabic-speaking refu-gees who attended a seven-week Health School as a part of their intro-ductory planning. The study was based on qualitative data obtained by participatory observation and oral group evaluations with 65 course participants. In addition, we used a questionnaire with closed response alternatives for self-rating health-related quality of life, including sleep and recovery. The questionnaire was administered at the beginning and end of the group activity as well as six months after the end. This sam-ple comprised 39 participants in the group activity who responded to the questionnaire on all three occasions. Furthermore, the thesis contains an article describing the Health School group activity/method, its background and theoretical links, as well as the collaborative process that developed between professionals and re-cipients. Results: The respondents in study I reported a high frequency of sleep- and fatigue-related complaints. Sleep disturbances on the equivalent of every other day were reported by 68 per cent and somewhat fewer, 43 per cent, reported regular problems with drowsiness, for instance drop-ping off during the day. Criteria for clinical insomnia were met by 41 per cent (36 per cent of the men, 50 per cent of the women), based on the combination of sleep disturbance and complaints of fatigue at least every other day. In addition, over 80 per cent of the sample experienced great anxiety about their family or other relatives in their home country. Many felt isolated and lonely, found it hard to get in touch with associations, have access to places for cultural activities, practicing religion and participating in sports. Many also experienced difficulties in gaining access to health care and dental care. In the educational situation (SFI), more than half had great difficulty in understanding what the teacher said and 68 per cent found it hard to keep up with the pace of the lessons. More than 64 per cent reported difficulties with concentration, problems with understanding homework and being able to do homework in a calm environment. Many respondents were uncertain about the introductory plan and roughly half had wanted their introductory officer to be more helpful in contacts with health care, including doctors, and housing matters. The qualitative part of study II, which aimed to elucidate the most im-portant issues according to the participants, gave rise to four categories: 1) More in-depth issues concerning the content of the group activi-ty/Health School, 2) Comments on the form and structure of the group activity/Health School, 3) Which of the participants’ “needs” were cov-ered by and which were missing, and 4) What the participants wanted to convey to administrators, decision-makers and politicians. The quantitative follow-up study showed that when the group activity started, the participants experienced a high degree of problems with sleep and concentration. Such problems were considerably less frequent at the end of the activity and this change persisted six months later. Moreover, the sleep disturbances were related both to the five variables of the health-related quality of life (mobility, activity, self-care, pain and anxiety/depression) and to the perception of general health. The variables pain and anxiety/depression showed significant improvements at the end of the activity as well as six months later. Men as well as women rated their general health as significantly improved at both follow-ups compared with baseline; the change was greatest for women. Conclusions: Taken together, the results show that in terms of self-rated health, the studied population has a high degree of problems with physical and mental ill-health. These problems are closely related to problems with sleep and concentration, besides having consequences for the newly-arrived persons’ daily activities and for settling in the host country. A great need of assistance from health care emerges, as well as a lack of trust in this, partly due to difficulty of access and a lack of professional interpreters. At the same time, the findings in this thesis show that the reception sys-tem with evidence-based inputs can achieve considerable positive changes for newly-arrived refugees. The self-rated health-related quality of life for participants in the group activity/Health School showed that for the group as a whole, the studied aspects had improved significantly both by the end of the activity and at the six-month follow-up. Proper actual knowledge about self-care and the Swedish health care system had increased significantly by the end of the activity. These effects can also have positive consequences for the next generation and others close to the participant. The group activity needs to be tested with other language groups of newly-arrived in order to warrant general conclusions.

From a BPS perspective, COPD and other chronic diseases may have a significant negative impact on those living with them and may be associated with higher rates of depression and anxiety and lower levels of health-related quality of life (HRQOL). Certain factors, such as spirituality, may influence the negative impact of chronic disease on the relationship between mood and functional independence and HRQOL. Also, gender may influence the relationship between mood, spirituality, and HRQOL for men and women living with chronic diseases. The current study included 136 patients undergoing physical rehabilitation at an IRF. Anxiety, depression, spirituality, HRQOL, and functional independence were evaluated for all. Mediation models were tested to determine the impact of spirituality on the relationships between mood and HRQOL and functional independence, and moderation models were tested to evaluate the impact of gender on the relationships between mood, spirituality, functional independence, and HRQOL. The current study yielded some inconclusive results but did evidence that COPD patients in acute inpatient physical rehabilitation facilities (IRF) have higher levels of anxiety than patients without COPD and also revealed that men with COPD have better HRQOL than do women with COPD. Spirituality was found to partially mediate the relationship between depression and HRQOL in IRF patients with COPD, but gender did not appear to moderate the relationships between mood, spirituality, functional independence, or HRQOL in IRF patients. As few studies on IRF patients with chronic diseases exist, continuing to evaluate patients in IRFs is important to enhance our BPS understanding of chronic disease.

Objective. Coronary heart disease has been on the rise in poorer countries and decreasing in developed countries over the last twenty years. However, the cardiac-related health-related quality of life (HRQOL) in poorer countries has not been studied. This study aimed to compare HRQOL following heart attack in a developing country in the East with that of a developed country in the West. Using the self-regulation of health and illness behaviour, the relationships between illness beliefs, coping cognitions and HRQOL are studied. Design. This study was a cross-sectional correlational survey and data were collected shortly before myocardial infarction patients were discharged from hospital. Methods. A sample of 243 individuals from the UK and Indonesia were recruited. Illness beliefs were assessed with the B-IPQ, along with coping cognitions (Brief-COPE) and health-related quality of life (MacNew questionnaire). Results. Illness beliefs and coping cognitions predicted HRQOL in the combined sample. Some aspects of socio-demographic and clinical variables were concurrently associated with HRQOL. Conclusion. The results demonstrate that people in the East have low illness beliefs and these are associated with worse HRQOL compared with those in the West. The findings suggest that there is an urgent need for smoking cessation campaigns in the East, while the West could benefit more from tailored-cardiac rehabilitation programme.

This dissertation concerning the theme "A comparison of the Contact and HRQOL concept in clients of nursing/old people´s homes" consists of a theoretical and practical part. The theoretical part firstly defines in detail the concept of the quality of life and the quality of life related to health (HRQoL ? health related quality of life). It also describes various methods of its evaluation. The next charter deals with the problems of aging and changes which arise with increasing age and are associated with a deteriorating health condition, as well as with situations and circumstances which may reset in a chase in the perception of the quality of life. The dissertation takes a closer look at the stay of elderly in some institutions for the elderly. The theoretical part compares the results obtained from elderly clients in an old people?s home using standardised SF-36 and Contact questionnaires. The SF-36 questionnaire is designed to measure the quality of life related to health and the Contact questionnaire serves to ascertain the frequency of contact between family and friends ant he elderly client. Data from both questionnaires were evaluated statistically and drawn up in the form of tables and graphs. This research showed a reduced perception of the quality of life of clients living in old people?s homes compared with the standard European population. In most domains of the quality of life there was no significant difference between clients with various frequency of contact with family and friends, and no difference was found n the evaluation of the quality of life between men and women.